Conservative management of paediatric atypical necrotising cervical lymphadenitis

This case report describes a case of probable non-tuberculous mycobacteria (NTM) cervical lymphadenitis with extensive necrotic skin involvement. A girl in early childhood had a 3-month history of unilateral submandibular swelling. This developed into an abscess which discharged following trauma. She subsequently developed a significant necrotic soft tissue wound and was referred as suspected necrotising fasciitis of the neck. Following multidisciplinary input, she was diagnosed with probable NTM cervical lymphadenitis. A joint decision was made to avoid surgical debridement and not to treat with antimycobacterial antibiotics. She healed completely without need for surgery within 3 months. A non-operative approach in a clinically well patient with probable NTM lymphadenitis can result in an excellent outcome, avoiding the risks of surgery in a child and long-term antibiotic therapy.